Patient Information

Coronary Artery Disease (CAD)

Coronary artery disease (CAD) occurs when plaque (made of fat, cholesterol, calcium, and other substances found in the blood) accumulates inside the coronary arteries, which supply blood to the heart. CAD is a narrowing of the arteries which reduces or blocks blood flow to the heart muscle (myocardium).
When coronary arteries are narrowed or blocked, oxygen-rich blood cannot reach the heart muscle. It can cause angina (chest pain) or a heart attack.
Since the symptoms of coronary heart disease are shown only in an advanced stage of the disease, it can take decades before a person with coronary heart disease will show signs of it. Over time, as the degree of CAD progresses, there can be a severe obstruction of the coronary arteries which blocks the flow of oxygen–carrying blood to the heart muscle. This weakens the heart muscle and may lead to heart failure.
Coronary Heart Disease is the largest major killer of American males and females. In the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women.

Peripheral Artery Disease (PAD)
Peripheral artery disease occurs when the peripheral arteries are narrowed or clogged with fatty deposits and plaque. PAD most commonly affects blood flow to the legs. Blocked blood flow can cause pain, numbness and infection. If severe enough, blocked blood flow can cause tissue death (gangrene). PAD is the leading cause of leg amputation.
PAD  is a common, yet serious disease. Men are more likely to have symptoms of PAD, but both men and women can develop the disease.
PAD can impair physical health and diminish the ability to walk.
In the advanced stages of PAD, blood flow to one or both legs can be completely or mostly blocked. This is known as chronic critical limb ischemia (CLI). A very severe blockage in the legs and feet means that the legs do not receive the oxygen or nutrition needed for cellular or skin growth and repair. CLI may lead to painful leg or foot sores, and it could eventually lead to gangrene. If this condition is left untreated, the foot or leg may need to be amputated.
Early diagnosis and treatment of PAD, including screening high-risk individuals, are important to prevent disability and save lives. PAD treatment may stop the disease from progressing and reduce the risk of heart attack, heart disease, and stroke.
Peripheral Artery Disease (PAD) is prevalent in the western world, afflicting a staggering 8–12 million Americans and contributing to significant morbidity and mortality. The prevalence of lower extremity arterial disease is ~17% for people between the ages of 55 and 74 years with millions in America and Europe developing ischemic symptoms each year.

Chronic Total Occlusions (CTO)

Chronic Total Occlusion remains one of the more difficult challenges for interventional cardiologists and radiologists.
CTO is defined as the complete blockage of the artery with no angiographically detectable antegrade flow, which is >1 month old. A chronic total occlusion is a chronic complete arterial blockage.
Chronic total occlusions are observed in approximately 40% of symptomatic PAD patients and 30% of CAD patients referred for invasive revascularization.
The current treatment options for CTOs are Percutaneous intervention, Bypass surgery and medical management. The dense, fibrous composition of CTOs, often makes traversing these arterial obstructions with a guidewire and balloon catheter impossible or too risky and therefore approximately two-thirds of CTO patients are referred for Bypass Graft or left untreated due to poor prognosis.
The success of the percutaneous intervention is also highly dependant on the operator skill and case selection criteria. However, successful revascularization improves anginal status, increases exercise capacity, and reduces the need for late bypass surgery.


Treatment Options

Bypass Surgery

The Bypass surgery creates new pathways around the narrowed or blocked arteries to enable more blood and oxygen to flow to the target area.
The bypass surgery uses a piece of a vein from the leg or artery from the chest or wrist. The surgeon attaches this to the artery above and below the narrowed area or blockage. This allows blood to bypass the blockage.
The limitations of the bypass surgery include significant patient morbidity, risk of surgical mortality, and high expense.

Percutaneous Intervention

Angioplasty is a procedure to restore blood flow through the narrowed or blocked artery. The physician threads a guidewire and a catheter mounted over it into the narrowed part of the artery. The catheter has a tiny balloon on the end. The balloon is inflated to open the narrowed artery and flatten the plaque against the artery wall. This widens the artery and restores blood flow.

Source:
MedlinePlus, a service of the US national library of medicine and NIH
American Heart Association